stemi case review and lessons learned
TRANSCRIPT
Kalah Erickson BAN RN- STEMI Nurse Navigator Sanford Medical Center Fargo
STEMI Case Review and Lessons Learned
162
STEMI CASE STUDIESKALAH ERICKSON, BAN, RN
STEMI NURSE NAVIGATOR
SANFORD MEDICAL CENTER FARGO
DISCLOSURES
• No personal or financial disclosures
TIME SENSITIVE METRICS
• Door to EKG• 10 min
• Door to EKG Interpretation• 10 min
• Door to STEMI Activation• ASAP
• Door in Door Out• 30-45 min
• Referral Door to PCI• 120 min
• FMC to EKG• 10 min
• FMC to STEMI Activation• ASAP
• Scene Time• As short as possible
• FMC to PCI• Straight to a PCI Center – 90 min• Stop at Critical Access Hospital – 120
min
Hospital EMS
TIME SENSITIVE METRICS
Early Activation
+
Early Recognition
+
Timely Transport
+
Timely Reperfusion
=
Saved Heart Muscle/Quality of Life
CASE STUDY #1
911 was called for an elderly male patient that awoke with CP radiating into his L arm and jaw
• 0526 – EMS arrived on scene to find this patient to be pale and diaphoretic
• 0528 – 12L EKG obtained
JB – E1751372
CASE STUDY #1
• 0549 – Pt in VT – defib x1
• 0551 – Pt cardioverted x1 for VT with a pulse
• 0601 – Pt arrived to Critical Access Hospital ED
• 0605 – 12L EKG obtained
CASE STUDY #1
• 0611 – Sanford Fargo One Call notified of STEMI patient
• 0616 – EMS dispatch notified of the need for patient transfer to Fargo
• 0620 – EMS at patient bedside in the ED
• 0631 – EMS departed the ED with patient, on the way to Fargo
CASE STUDY #1
• 0718 – Patient arrive to SMCF Cath Lab
CASE STUDY #1
Patient discharged 2 days later!Early recognition of a STEMI is key for these
patients
The clock to stent placement starts with
the STEMI EKG
Great Door in Door out Time for the Critical
Access Hospital!
CASE STUDY #2
911 was called for an 83 year old male with c/o jaw pain and chest pain
• 1040 - A local BLS EMS service arrived on scene
• 1046 – 12L EKG obtained
RA – E1631450
CASE STUDY #2
• 1059 – EMS departed the scene to intercept with an ALS EMS service
• 1122 – ALS intercept
• 1156 – EMS arrived to the Critical Access Hospital ED with patient
• 1159 – 12L EKG obtained
• 1233 – 12L EKG obtained Serial EKG’s are VERY important!!!
CASE STUDY #2
• 1235 – Sanford Fargo One Call notified of STEMI patient. Sanford AirMed dispatch notified of the need for patient transfer
• 1246 – TNK administered to patient• THIS STOPS THE CLOCK TO PCI
• 1323 – Sanford AirMed staff at patient
• 1333 – AirMed departed the ED with the patient, on the way to SMCF Cath Lab
CASE STUDY #2
• 1554 – Patient arrived to SMCF Cath Lab
CASE STUDY #2
Patient discharged 2 days later!
Great initial EKG time from EMS = early
recognition!
Early activation after early recognition is
key for STEMI patients
This hospital knew that due to their location, the patient needed
Lytics
CASE STUDY #3
• 2256 – 53 year old male presented to a Critical Access Hospital ED with c/o chest discomfort x3 days. About an hour PTA, the pain suddenly increased. • 12L EKG obtained
GT – E2534506
CASE STUDY #3
• 2307 – Sanford Fargo One Call notified of STEMI patient• Due to the weather, air transport was not an option
for this patient• End of October
• 2327 – Local ground EMS dispatch notified of the need for a transfer
• 2330 – TNK administered to patient • THIS STOPS THE CLOCK TO PCI
• 2338 – EMS at patient bedside
• 0007 – EMS departed the ED with patient, on the way to Fargo
CASE STUDY #3
• 0132 – Patient arrived to the SMCF Cath Lab
CASE STUDY #3
Patient discharged 3 days later!
Great door to EKG time!!
The goal for Door to Lytics is 30 minutes
Make a plan with the Physician at the PCI center, have an RN ready to draw it up
and administer
Even after TNK is given, it’s important to get the patient out the
door as soon as possible
CASE STUDY #4
911 was called for a 52 year old female with CP
• 0810 – EMS arrived to find pt with c/o CP starting around 0600. Pt stated she felt her body was on fire and she was dizzy
• 0821 – 12L EKG obtained
SP – E5620039
CASE STUDY #4
• 0823 – EMS departed the scene
• 0826 – Sanford Fargo One Call notified of STEMI patient
Sanford Fargo
One Call
CASE STUDY #4
• 0917 – Patient arrived to Cath Lab
pLADPre PCI
pLADPost PCI
mRCAPre PCI
mRCAPost PCI
CASE STUDY #4
Patient discharged 2 days later!
Sometimes in rural ND and MN
cell phone reception isn’t
the greatest
EMS bypassed the critical access
hospital (to avoid backtracking) and came directly to the PCI Center
TAKEAWAYS
• Minutes matter for these patients!• Critical Access Hospital
• Early Recognition (EKG) and Early Activation (Calling the PCI Center are key for these patients, their recovery and quality of life after an MI
• Know which PCI center you typically send MI patients to
• Know which transport you normally use (Ground vs. Air)
• Know the importance of serial EKG’s
• Providers – have the discussion regarding Lytics with the accepting Provider
• EMS• Early Recognition (EKG) and Early Activation (Calling the PCI Center are key for these patients,
their recovery and quality of life after an MI
• Know how far you are from the Critical Access Hospital vs the PCI Center
• Know the importance of serial EKG’s while transporting a patient
